P - 76426�������i ✓�C�7���1�f
ORDER R PAYMENT NO.
L-- d d� 7- vo �a �DER �1� PAYlVfE1�T
Installer of Wiring
Owner/Occupant__ ��'�^-�.. /��-i � � ��2,.� s" Job �-� ���"�
1�
Property Address �J�"J ��• � S%, ZiP �
Date �� % S— 6� Permit No. �- �� j�`f� C Date Filed /-/ 7-v 7
�Additional rough-in inspection was required.
� No access - scheduled inspection.
❑ Fee shortage - see computation.
❑ Reinspection fee.
Fee Computation: __ � ��, ��2.
� JA / L�
-
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� CITY OF FRIDLEY �i'�n� �•- L_� ��
6431 UMVERSITY AVE NE --
FRIDLEY MN 55432 � t-------
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Please return this order with your check in the amount of � �1 ' payable to the city/
township by (date) �t - 'z- � - c 7
Inspector_ F/'(c��� �^��� �C-s'''^' Telephone � s� %� 7, 7�?SS
RETURNTHIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERETHE JOB IS LOCATED. RC-02